Multi-Country HTA Initiatives Versus National HTA Processes: The Optimal Reimbursement Strategy


Gillard S, Ioannou P, Bashford-Bovens SM
Mtech Access Ltd, Bicester, UK


Health technology assessment (HTA) plays a crucial role in the reimbursement decision-making process in many countries, but recommendations vary widely throughout jurisdictions, even for the same drug. To harmonise methodological standards and foster collaboration among European HTA bodies, several joint HTA initiatives have been established. Our review aimed to provide a concise overview and comparison of joint HTA and drug price collaborations and to gain an understanding of how these impact pricing and market access.


A targeted literature review was conducted to identify active multi-country HTA and pricing initiatives. Information was retrieved from healthcare authority websites, peer-reviewed articles, and grey literature. A qualitative analysis compared the scope, objectives, member countries, process requirements, number of therapies reviewed, and final decisions across the initiatives.


Seven large EU multi-country collaborations were identified: EUnetHTA (2006), Valletta Declaration (2017), BeNeLuxA (2017), Nordic Pharmaceutical Forum (2017), FINOSE (2017), FAAP (2017), and Baltic Procurement Initiative (2012). The Head of Agencies Group is the latest initiative launched in 2021 with the aim to facilitate collaborative ‘high-level strategic exchange and discussion’. Although all initiatives aim to improve market access, their scope differs and may encompass horizon scanning, joint HTAs, joint pricing and reimbursement negotiations, and/or information sharing. To date, noteworthy results have only been achieved by the EUnetHTA (66 collaborations) and BeNeLuxA (7 joint HTA procedures). BeNeLuxA also initiated the International Horizon Scanning Initiative in 2019. Here we summarise the challenges that orchestrating such HTA initiatives faces, e.g. variable treatment pathways and healthcare systems, unique HTA perspectives (e.g. patient-relevant endpoints, subgroups), and significant differences in willingness-to-pay, along with future considerations.


Multi-country HTA/pricing collaborations may reduce potential delays arising from duplicative manufacturer submissions and benefit countries without established HTA infrastructure. Willingness from both payers and pharmaceutical companies to engage in the process is paramount for success.

Conference/Value in Health Info

2022-11, ISPOR Europe 2022, Vienna, Austria

Value in Health, Volume 25, Issue 12S (December 2022)




Health Policy & Regulatory, Health Technology Assessment

Topic Subcategory

Decision & Deliberative Processes, Reimbursement & Access Policy


No Additional Disease & Conditions/Specialized Treatment Areas

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